Tennis Elbow, or Lateral Epicondylitis, is a condition where repetitive or direct trauma has resulted in micro-tears of the wrist extensor muscles at the musculotendinous or the tenoperiosteal junctions of the lateral epicondyle, or possibly both, leading to irritation, inflammation, swelling, weak grip, lack of hand coordination and pain at these locations of injury.
ln today’s high-tech climate of typing, mousing, texting and gaming, Tennis Elbow is far-reaching in a number of things that have nothing to do with “tennis”. A fall, repetitive, jerky or sudden motions, heavy lifting of a briefcase or suitcase in the palm-down position, or the overuse of a screwdriver can all cause trauma and injury to the wrist extensor and supinator groups and the onset of symptoms.
Tennis elbow affects people who are in the age group of 35-65 years, usually associated with a pain on the outside of the elbow. As the name might suggest, but it does not affect only tennis players, in fact, 95% of all reported cases in the United States alone are not reported by tennis players. A better understanding of the various groups of people more susceptible to tennis elbow actually aids faster diagnosis, and there is a high probability that such people might not know they are part of the high-risk category. Affected people usually ignore tennis elbow symptoms till it becomes a chronic problem. Based on the occupation/sports that a person is engaged in, there are two major group of people that are susceptible to tennis elbow:
1. People engaged in manual labor: There is a strong correlation between the type of activity a person engages in and tennis elbow. Since manual labor involves lifting of heavy weights or involves more than normal stress on the wrist, arm, and elbow. People like laborers, carpenters, plumbers are usually a high risk category for tennis elbow. ln addition, tasks that involve long durations of wrist and elbow movement like painting also can lead to tennis elbow. Apart from manual laborers, there are also weightlifters that are a part of this high risk category, especially professional weightlifters that have been lifting weights since a very young age, make themselves susceptible to tennis elbow.
2. Athletes: lt is named tennis elbow because tennis players were one of the first group of people who reported the problem. However, people who are engaged in racquet sports like badminton are also equally susceptible to tennis elbow. Athletes like golfers and those competing in more weight oriented sports like the shot-put and the discus throw have also been known to be affected by tennis elbow. Essentially, athletes that are affected are those susceptible to wear and tear of the forearm, and elbow or those that require extensive wrist movement.
TENNIS ELBOW BRACE
Many braces have compression as their primary purpose. The compression is used to keep the inflammation from expanding and to help force the lymph fluid back into the bloodstream. Reducing the swelling also reduces the amount of pain.
It also limits the mobility of the arm at the elbow. This helps prevent the arm from extending to its limit and causing more strain on the tendon and surrounding tissue, and thus more pain. lt also helps promote rest in the arm. When the purpose of the design is to provide heat to the elbow, it is promoting circulation in that area. That helps the blood take lymph fluid away from the wound and bring oxygen and nutrients to the wound.
In choosing a tennis elbow brace, it is important to consider its fitness. Usually, any of them will fit any arm greaterthan the size of a child’s arm and lessthan the size of a large footballplayer’s arm. But sometimes a person with a small arm, such as a petite woman, inadvertently selects a brace that flops around on her arm. Especially if you will be wearing your tennis elbow brace for a lengthy period of time and in higher temperatures, you will want to make sure that the brace is breathable and absorbs perspiration. You will probably prefer a lighter weight material, but not so light that it doesn’t limit the range of movement at all in the elbow.
With all the claims that are made regarding which tennis elbow brace is the best (and some even say that wearing any brace is bad for the condition), it is important that you monitor the condition of your arm over a week or two. You’ll want to make sure that you are indeed getting an ample benefit from your purchase. lf you find that it is not working for you, question whether you are using it correctly and consider a different design.
The Use of Neoprene
A large percentage of tennis elbow braces are made from neoprene. This material works well when in contact with the body. lt is used for garments worn in sports, like wetsuits. Neoprene works well in a few different ways. lt provides cushioning in the event that the elbow gets bumped. lt can take the energy of a localized impact to the arm and spread it across a wider area.
It dampens vibrations when playing tennis and doing other activities. Neoprene is great for providing iormfitting compression and does a fine job at limiting mobility. lt is excellent at retaining heat around the injury.
The Primary Designs
One special type of brace has the primary function of applying external heat to the arm. To do this, it comes with one or more gel packs that can be heated in the microwave and inserted into the brace before wrapping the arm in the brace. Usually, this type of brace also allows those same gel packs to be put in the freezer” so the brace can also be used to apply an icing treatment to your elbow.
Another type of brace is meant only for applying the icing treatment to the arm. To do this, you put the entire brace in the freezer before wrapping your arm. There is a type of brace called an Epicondyle brace. lt is designed to put pressure very specifically on the spot where the tendon is attached to the elbow bone. That spot is called the Epicondyle.
There are several good tennis elbow braces to use when recovering. A properly fitting tennis elbow brace will reduce most of the pain and can prevent further damage. There are several tennis elbow braces that can be purchased. Here are a few of the most popular:
- The Aircast pneumatic tennis elbow armband: lt utilizes a single pre-inflated air cell to concentrate compression on extensor muscle for more support and less constriction. This is a very durable brace and will last for years.
- The Band-lt tennis elbow brace was Designed by world-renowned orthopedic surgeon and sports medicine specialist, Donald Fareed, M.D. lt focuses compression on the extensor muscle like the Aircast. However, it utilizes plastic insert attached to an adjustable strap.
- The most notable elbow brace available may be the Bauerfeind EpiTrain elbow support: This brace is a unique knitted elbow support that incorporates two anatomically contoured silicone inserts. These silicone inserts leave the elbow bones pressure-free and provide an intermittent compression to the soft tissue of the elbow joint which leads to increased circulation.
TENNIS ELBOW TREATMENT
Rest can help, but to correct the disorder at its root cause, rehabilitation therapy, if performed correctly, can greatly increase the rate of recovery.
- Massage: This modality can help a lot with increasing flexibility and range-of-motion (ROM) back to the injured arm while reducing pain levels. Be sure that you find a competent massage therapist that specializes in sports injuries.
- Physical Therapy: The tools used by a physical therapist can often be very beneficial, such as T.E.N.S, Ultrasound, lnfra-Red Light laser, Sinewave, Phonophoresis and other modalities to help reduce pain and irritation, while increasing strength and flexibility.
Making sure that overly short, taut muscles in the upper extremity are lengthened is important in order to increase flexibility and dexterity of the tissues which in turn reduces the amount of tensile stress imposed on the antagonist muscles (extensors) as they try to maintain equilibrium around the wrist, elbow and shoulder joints.
- Shoulder: Anterior deltoid.
- Forearm: Finger and wrist flexors, forearm pronators and ulnar deviators of the wrist through the implementation of active Flextend stretches.
Strengthening long, weak muscles is critical for not only injury prevention but rehabilitation as well. Strengthening the muscles surrounding the elbow joint provide stability to the joint in all directions and is a necessity for athletes of all types, especially tennis players, in order to prevent eliminate the existing disorder as well as prevent future damage to the extensor group.
- Shoulder: Posteior deltoid.
- Forearm: Finger, wrist and elbow extensors, forearm supinator and radial deviators of the wrist, utilizing active Flextend exercises.
- lmprove your technique: No matter your level of tennis expertise, everyone can improve their backhand technique, such as; to stop leading with the elbow and/or switching from a one-handed backhand to a two-handed backhand. Both of these greatly reduce stress to the wrist extensor and supinator muscle groups.
- Strengthen your muscles: Strong muscles are far less likely to become injured. Make sure that all of your upper extremity muscles are strong and healthy, especially the finger, wrist and elbow extensors, and wrist/forearm supinator, as these are the muscles that are usually weak and become injured when playing tennis.
- Handle size: A smaller handle is better than a larger handle, but the best one is made to fit your hand.
- Use quality equipment: Choose a racquet that is light in weight and has a larger face in order to help hit the ball more “centered”, which reduces vibration and twisting of the racquet.
- Ball Speed: Choose the type of ball that matches your level of expertise. lf you are a novice, choose a slower ball. lf you are an expert, choose whichever ball you like to suit your purpose.
- Racquet Strings: For novice to intermediate players, use a racquet that is more “loosely” strung, while advanced players can use whatever they like.
TENNIS ELBOW CAUSES AND SYMPTOMS
For tennis players, lateral epicondylitis results from:
- A poor backhand technique in tennis.
- A racquet grip that is too small
- Strings which are too tight
- Playing with wet, heavy balls
Lateral epicondylitis can also be a result of overuse or repetitive strain caused by repeated extension (bending back) of the wrist against resistance. Besides various racket sports, it is also common after periods of excessive wrist use in day-to-day life. Since certain activities are more likely to affect a particular part of the elbow or arm, the symptoms experienced by people suffering from tennis elbow also vary, whereas pain on the outside of the elbow is a common symptom other than that the symptoms can vary from shooting pain in the forearm, to pain while lifting weights or pain during simple activities like using a wrench.
Signs of lateral epicondylitis are:
- Pain about just down from bony area at the outside of the elbow
- Weakness in your wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone
- Pain on the outside of the elbow when the hand is bent back (extended) at the wrist against resistance
- Pain on the outside of the elbow when trying to straighten the fingers against resistance
There are two ways you might notice the start of lateral epicondylitis:
- Sudden Onset: Sudden onset of lateral epicondylitis occurs in a single instance of exertion such as a late backhand when the extensors in the wrist become strained. This most probably corresponds to micro-tearing of the tendon.
- Late Onset: This usuallytakes place within24-72 hours after a period of unaccustomed wrist extension. Examples might be a tennis player with a new racket or even a person who,s spent a weekend doing “do-it-yourself” projects around the house. Examples might be using hammers, screwdrivers or heavy electric or gas powered tools.
Depending on the particular tendon group that is damaged and other deciding factors, differential diagnosis of tennis elbow is divided into categories like anconeus compartment syndrome, bursitis, cervical radiculopathy, radio-humeral joint dysfunction, lateral epicondyle avulsion, musculocutaneous nerve entrapment, non-union of radial neck fracture, osteoarthritis, posterior interosseous syndrome, posterolateral rotatory instability, radial nerve tension, radial tunnel syndrome, rheumatoid arthritis, strained lateral collateral ligaments and snapping plicae syndrome. lt is a relief to know that tennis elbow is curable and when diagnosed on time, the time taken to recover is less.